The New International, January 1939

James Rorty

Socialized Medicine

WILLIAM HARVEY’S article What is Socialized Medicine? in the December issue seems to me on the whole to be the most intelligent handling of the subject, from the labor point of view, that I’ve seen. The following paragraphs are designed to supplement and interpret Mr. Harvey’s necessarily compressed treatment.

1) Such socialization of medicine as we have had thus far has been along the line of “socializing losses.” Medical schools and hospital became unprofitable, so they were subsidized, first by philanthropy, and then when philanthropy faded, by government. Present government support is quite inadequate. Both group hospitalization and the wider plan soon to be announced which combines ward service and medical care while in the hospital, and is designed to tap the next-lower stratum of workers, represent an application of the insurance principle to the payment of costs. But the object is to throw the financial load back on the lower middle class and white-collar workers. These developments do, however, represent an administrative advance and give workers somewhat more for their money. It is, of course, of the greatest importance, that workers be educated to demand appropriate representation on the control broads of all such voluntary developments.

2) Since the national health conference, medical societies all over the country are trying to anticipate and abort any real program of compulsory health insurance and/or state medicine by offering something “just as good.” Workers should clearly understand the motivation and purpose of these medical society schemes. The medical hierarchy is determined first to segregate the sector of paying fee-for-service practice and keep control of it for themselves. Worse than anything else they fear the type of group practise, group pre-payment, medical cooperative of which the Group Health Association of Washington, D.C. is the most publicized example. They fear this development first because it represents an equitable and necessary control by the patients of the medical service which they receive; second, because the numerous economies of group practice including the elimination of the vicious system of fee-splitting, now so prevalent, enable the well-managed medical cooperative to compete the average fee-for-service rugged individual practitioner out of business.

Instead of these technically and socially advanced forms of medical service, the medical societies are now shouting for medical indemnity insurance which is neither new nor in the least useful; also for vastly voluntary pre-payment schemes, wholly controlled by organized medicine, such as that recently projected in California. In general workers will be well advised if they carefully avoid anything that organized medicine is for.

3) The dark horse of this whole controversy is, of course, the drug interests. Only a little more than a year ago the president of a nrominent manufacturer of “ethical proprietaries” circularized the medical profession with a proposal to raise $400,000 a year from his group with which to help organized medicine fight health insurance. Recently Dr. Fishbein addressed the Drug and Chemical section of the NY Board of Trade. Because of the huge advertizing income of the Journal, AMA (nearly a million dollars) the community of interest between the “medicine men” and organized medicine is well established. Health insurance, both voluntary and compulsory, would tend to deflate both of them. Any genuine social advance on the health sector will have to fight the same lobby that defeated the Tugwell bill.